Human Studies 27: 37–50, 2004.

A CRITICAL APPRECIATION OF ERWIN STRAUS 37

© 2004 Kluwer Academic Publishers. Printed in the Netherlands.

The Discipline of the “Norm:” A Critical Appreciation of

Erwin Straus1

RICHARD M. ZANER
Ann Geddes Stahlman Professor Emeritus of Medical Ethics and Philosophy of Medicine,
Vanderbilt University Medical Center, Nashville, TN 37232-4350, USA
(E-mail: rzaner@houston.rr.com)

Abstract. As a practicing physician (psychiatrist), scientist (neurologist) and philosopher,

Erwin Straus developed a body of writing which, falling within the phenomenological tradi-
tion, is highly original and insightful. His unusual combination of work from these three ar-
eas constitutes one of the most important attempts to provide what has been called “a new
Paideia.” Regarding this unique blend of perspectives and concerns as quite natural, he con-
ceived his work variously as a “medical anthropology” or “phenomenological psychology.”
In the end, he was both a pioneer and a rebel: starting from psychiatry, he proceeded boldly
straight into phenomenological philosophy, illuminating significant aspects of human life: if
we would understand the “norm,” we must begin with the disruptions, as failures of existen-
tial projects; that is, as forms of human life – which was ultimately at the heart of his life-
long epistemic and therapeutic concerns.

On Understanding Straus

Both medicine and philosophy reach back into the deep antiquity of Western
history, share much of their respective origins in Greek and earlier times, and
have a frequently common focus of attention: human life or beings individu-
ally and collectively. It is for those very reasons quite striking that so few
practitioners in the history of either enterprise ever took the other into account,
or gave much thought to how they relate to, and perchance even might ben-
efit from, one another.
Edmund D. Pellegrino has convincingly argued that not since early Greek
times has either endeavor understood itself or the other as engaged in any-
thing that is common – they have neither shared insights nor deliberately made
use of each other’s concepts and methods (1979, pp. 66–91). The Greece of
antiquity, on the contrary, was almost the only period when physicians and
philosophers were jointly and significantly involved in producing the com-
mon cultural sense which Werner Jaeger termed “the ideal of Paideia” (1944)
– that remarkable synthesis in which philosophy and medicine were, in
Pellegrino’s words, “the major determinants of the dominant image of man”
(1979, p. 75).
38 RICHARD M. ZANER

Indeed, after classical times only a handful of physicians and philosophers

had much to do with each other’s home discipline – at least not since Galen in
the 2nd century AD. When that did happen, relations were usually troubled,
not especially friendly. Thereafter, at least until the last few decades, most
physicians diagnosed philosophers, so to speak – when they were at all in-
clined to be aware of them at all – as more or less endemically inflicted with
a sort of linguistic diarrhea, intractable though not infectious. For philosophers,
on the other hand, physicians seemed in need of what Sigmund Koch once,
with marked sarcasm, said about psychology, an epistemodectomy: a thorough
resection of basic assumptions about human life, especially mental life.
And, on the other side, philosophers seemed comfortable only in academic
arenas, and continued to have little detectable impact on the wider society even
after thirty years of so-called medical ethics. They have thus “become lost,”
Pellegrino was moved to observe in a not altogether unkindly turn of phrase,
“in an intellectual oomphaloskepsis in which [their] positivist and analytic bent
have culminated” (1979, p. 81).
It was, of course, René Descartes – physician, scientist and mathematician,
later turned philosopher – who gave credibility to one of the first alliances of
medicine with empirical science. He was, for instance, the first notable per-
son to endorse the work of Harvey on the circulatory system (he claimed to
have seen it “from my own experience,” as he wrote in 1638 to the Dutch
physician, Vopiscus Fortunatus Plemp) – and who also indelibly marked medi-
cine and its main dualistic view of itself (Lindeboom, 1978; Zaner, 1988, pp.
92–153; Risse, 1971, 1972). Since then, however, Pellegrino argues, any in-
fluence by philosophy largely dissipated, with medicine developing on its own
as “a strong, independent discipline, rich in theoretical and practical accom-
plishments” (Pellegrino, 1979, p. 76).
In light of that historical background, Erwin Straus’ accomplishments (not
to say his interests and educational background) are extraordinary. His pro-
fessional career was as a physician (psychiatrist) and scientist (neurologist),
yet he possessed an uncommonly mature and compelling philosophical apti-
tude. His numerous insightful papers and books display his strong commit-
ments to both disciplines and to the need to interrelate them constantly. Viewed
historically, such a blend is all the more remarkable. If we were to search
through 20th century medicine for someone comparable to Straus, only Jan
Van den Berg and Karl Jaspers come to mind as likewise exceptional.2
Equally unusual was Straus’ sense that a profoundly close connection be-
tween these enterprises was quite natural, for he understood (as did the phi-
losopher, Max Scheler (1952, pp. 5–6)) that we have in our times become more
enigmatic to ourselves than ever before in human history. Moreover, just be-
cause of that, Straus believed that philosophy and medicine had inherited an
urgent and special responsibility to rectify that imbalance – a conviction he
shared with a few philosophers, such as José Ortega y Gasset, Alfred Schutz
 A CRITICAL APPRECIATION OF ERWIN STRAUS 39

and Gabriel Marcel. The task adumbrated by that responsibility centrally in-
volved, he believed, critically understanding the human condition (a major
undertaking of philosophy) and at the same time caring for and helping one
another to promote both individual good and the common weal, especially in
the presence of illness, grief and loss (the ultimate focus of both medicine and
psychiatry). Straus actively responded to this awesome and earnest challenge
to develop what may be termed a philosophy of medicine (he variously termed
it “medical anthropology,” “anthropological psychology,” or “phenomen-
ological psychology”). Indeed, he saw this – and his constant effort to engage
both disciplines in dialogue – as imperative, however novel such an under-
taking was for both enterprises.
On the other hand, it should be noted that a search for philosophers who
are even interested, much less well-trained, in clinical or research practices
such as medicine would turn up but one prior to the early 1970’s – Scott
Buchanan, whose interesting study, The Doctrine of Signatures, first published
in 1938, fell on deaf ears until its republication in 1991 (urged by Pellegrino;
it unfortunately still remains almost unknown). After 1970, only a few have
been seriously concerned with issues beyond a narrowly understood ethics,
although the mushrooming interest in the topic in Europe is rapidly compen-
sating for that.3 Pellegrino’s call for “a new Paideia,” thus, may well be some-
what impertinent and ill fated and perhaps even impossible – but whichever,
it is clear that Straus and Pellegrino, colleagues for a time,4 shared the same
fundamental vision – one which seems to me vital for understanding much of
Straus’ published oeuvre.
It will not in the least seem odd, accordingly, that my discussion of Straus’
ideas – although I must admit to woeful ignorance of so much of his published
writings – must take into account his unique blend of background, concerns
and practices, even while Straus himself made little of this exceptional fact
of his own life and career. As I said, he regarded it as quite natural and neces-
sary and spent very little effort on its rationale and justification. With that in
mind, I want to make a few suggestions about the matter.

The “Medical Anthropologist”

The singular feature of Straus’ work is perhaps best captured by the way he
sometimes entitled his work: “medical anthropology” – a discipline which he
felt, and Pellegrino has long agreed, has become especially exigent today. It
should be pointed out, however, that while those involved in the psychiatric
movement that came to be known as Daseins- or existential-analysis (May et
al., 1958) knew Straus’ ideas well (Jaspers, 1963, pp. 540–545; Minkowski,
1970 where he cites Straus only as a “theoretical psychologist”), it unfortu-
nately remains the case that far fewer have taken the time to dwell on his philo-
40 RICHARD M. ZANER

sophical themes and approach. Herbert Spiegelberg’s observation—that Straus

was a “pioneer” – is completely warranted, as is his sense that Straus was “a
rebel” (1972, p. 278) who, while respecting and learning from others, never-
theless often parted company with them to go his own way on some very
central matters.
For instance, while deeply appreciative of the two giants of 20th century
continental philosophy, Edmund Husserl and Martin Heidegger, Straus was
expressly antagonistic to Husserl’s philosophical notion of the transcenden-
tal (1966, p. xi), and was equally critical of Heidegger for not having allowed
any apparent place for organic life, the human body – the “animalia.” Hence,
even while Husserl of course had a great deal to say about the organism as
embodying the person (Zaner, 1964/1970), neither he nor Heidegger had much
to say about bodily disease or mental illness (Straus, 1969, pp. 1–84, esp. 42–
54; see also Spiegelberg, 1972, pp. 267, 274–75).5 It is also worth noting in
passing that Straus had some basic disagreements with his close friend and
associate, Ludwig Binswanger, on both psychiatric and philosophical matters
(Mishara, 1997, pp. 63–64).
Straus was always quite clear about which themes were essential and how
best to approach them. In the most general terms, he typically began any in-
quiry with his patients and their conditions. Clearly central for him was a focus
on understanding them as full, individual persons whose ways of being-in-
the-world that brought them to his attention consisted of disruptions and
dis-lodgments from the way things usually are, from the “everyday” or
“Lebenswelt,” that is, from the “normal.”
Straus’ way was first and foremost to begin “afresh from the phenomena”
(Spiegelberg, 1972, p. 265); he was, that is, most often motivated by some
individual patient’s plight and circumstances – whose condition was then, in
fine Husserlian style I might note, taken up as an example for philosophical
reflection (Zaner, 1973, pp. 29–43). Anyone who chances to read Straus,
moreover, must surely marvel at his style, always marked by “the charm and
appeal of the sudden inspiration, the literacy grace, and the humorous touch…
[Indeed,] few phenomenologists have combined so much of the artist with the
scientist,” Spiegelberg rightly noted (1972, p. 265).
But even while true, that praise risks missing what seems to me a central
feature of Straus’ work: while any individual whatever can (and for medical
purposes must) be considered for his/her own sake or as the unique person
each is, each can at the same time be considered as an example, that is as
exemplifying certain essential traits and characteristics that may then them-
selves be focused on and studied. It is in just this sense, it seems to me, that
Straus has contributed importantly to one of the more significant aspects of
phenomenological methodology, what Husserl termed “free-fantasy variation.”
More on this momentarily.
 A CRITICAL APPRECIATION OF ERWIN STRAUS 41

In somewhat different terms, Straus understood himself as in the strictest

sense working within and guided by what I might term the discipline of the
phenomena. And, the phenomena which captured his attention, I believe, were
above all his patients, disoriented and disturbed, unique and ungetaroundably
individual, and whose lives embodied utterly concrete appeals for help and
understanding. In this, I am convinced, Straus is a direct and truly innovative
descendant of the ancient Greek tradition, the Methodist or skeptic: the phe-
nomena themselves (that is, patients precisely as they present themselves to
the physician) constitute the “law” of practice, therapy and thinking (a point
to which I shall shortly return) (Edelstein, 1967, pp. 187–201).6
Just so, Straus often emphasized, medicine, and especially psychiatry, must
focus on and care for patients in all their individuality, and who in their very
helplessness and vulnerability present an appeal for help, understanding and
being understood – a full sense of therapy that is most clearly achieved by
means of careful listening and attunement to these phenomena themselves.
While he devoted his professional life to his patients, therefore, at the same
time he undertook to think about each of them as examples, as exemplifying
certain forms of life which, even while distinctively human, had to be under-
stood as deviations from the “norm.” He thus sought not only to help each
unique patient within his or her concrete circumstances and needs, but as well
both to understand and be understanding of each individual. Only then, al-
ways and only from that base, he undertook the long and arduous journey to
a broader, more embracing thematic of la condition humane that defined his
work: the “medical anthropology.”
It is striking that Straus’ central concerns, then, began with those he saw as
definitive for the true physician, psychiatrist and neurologist; he was, that is,
a clinical practitioner who yet had an amazing reach and breadth of intellect
that took him into the rather more austere regions of phenomenological phi-
losophy, even while he continues to be regarded as a somewhat marginal fig-
ure (Embree, 1997).7 It is in any event as a clinician that I find him most
intriguing. And it is here, I think, that we will find the proper way to appreci-
ate this great and generous physician and scholar’s real contributions to our
lives and work. I hope, at least, to give this kind of appreciation a chance to
be aired.

A Rule of Method

There are two main themes to lay out. Both are straightforwardly methodo-
logical – despite Spiegelberg’s odd and, I believe, erroneous claim that “Straus
is no methodologist” (1972, p. 267).
First, Straus went to considerable lengths in most of his writings to make it
quite plain what he was up to, where and how he thought one had to begin an
42 RICHARD M. ZANER

inquiry, and where to go thereafter – which is the second theme I’ll return to
momentarily. It is rewarding to consider some examples.
“Psychoses are, so to speak, basic experiments arranged by nature; the clini-
cal wards are the natural laboratories where we begin to wonder about the
structure of the Lebenswelt.” Beginning in that way, he wrote in his essay,
“Norm and Pathology of I-World Relations,” “we begin to wonder” because
“we realize that, in order to account for its breakdown, we have to study its
norm first” (1966, p. 257). But focusing on what is “normal” regarding a par-
ticular “form of life,” we are brought up short, and “suddenly notice that we
are beginners in a field where we deemed ourselves masters.” The reason stems
from the most striking feature of everyday life: that it goes unnoticed (in
Schutz’s terminology, it is taken for granted), while on the other hand we read-
ily and easily accomplish what these “basic experiments” bring to awareness
precisely because they are disruptions of the “norm.”
Considering “Shame as a Historiological Problem,” as he terms it, he em-
phasized that, like every sickness, “perversions are pervasive modifications
of and disturbances in man’s communication with the world” (1966, p. 219).
Accordingly, the notion of “communicative mode is of fundamental impor-
tance for anthropological psychology.” His example in this case was “the
voyeur,” a person “who draws his sexual gratification from looking at another
lives continuously at a distance. If it is normal to approach and unite with the
partner, then it is precisely characteristic of the voyeur that he remains alone,
without a partner, an outsider who acts in a stealthy and furtive manner.” It is
then possible to appreciate “one of the paradoxes of this perversion,” namely,
that the voyeur seeks “to keep his distance when it is essential to draw near”
(1966, p. 219).
In “Disorders of Personal Time in Depressive States,” on the other hand,
he emphasized that “Our understanding of the psychopathology of time de-
pends on our understanding of its norm” (1966, p. 291). In each of these (and
numerous other) examples, Straus consistently took his own “clinical experi-
ence [as] my point of departure,” which then made a “next step” possible,
namely, reflecting on some “well-defined organic disturbance” – whether it
be voyeurism or the inability to orient spatially, for example to draw the floor
plan of a room or house. Observing carefully an example of the latter disor-
der “makes us wonder about the normal performance. . . In everyday life, we
take it for granted that a normal person will be able to draw . . . the floor plan
of a familiar room.” However, psychiatric experience quickly “puts an end to
such naive confidence. We discover a problem where we had seen none be-
fore. Obviously, an explanation of this disturbance has to wait for an adequate
understanding of the norm” (1966, pp. 256, 260). To understand, hence treat,
such an inability requires understanding the unproblematic ability, i.e., the
“norm.”
 A CRITICAL APPRECIATION OF ERWIN STRAUS 43

Each of his studies led him straight into fundamental issues and ultimately,
to what directly concerned him in several of them, such as his justly famous
probing of the upright posture (1966, pp. 137–165). He called his efforts
variously medical anthropology, psychological anthropology, or phenomen-
ological psychology, which opened up (and for him, required) an approach to
the basic questions of human reality, life, or being at whose root is our em-
bodied domain of “sensory experience” and bodily life in which each of us is
“a living organism . . . related to the Other as the Other” – the I-Allon rela-
tion (1966, p. 268).
In each case, he begins most concretely with himself in his daily clinical
encounters with patients. His reflections are methodically attained by begin-
ning with his understanding of himself as physician, psychiatrist, and neurolo-
gist which ineluctably committed him to the fullest exploration of the “norm”
from which his patients had in some way “deviated” – and thereby they pre-
sented appeals for help. His constant, abiding effort was thus at once to un-
derstand and to be understanding of his patients, to “apply aesthesiology to
pathology” (1966, p. 274) – and this was a deliberate and self-conscious de-
cision.
Straus is very clear about this: “Instead of proceeding from philosophy to
psychiatry [an approach he attributes to Binswanger] we shall start from psy-
chiatry,” that is, from his own clinical experience. Here, it seems to me, is a
fundamental and highly significant first rule of method – one equally signifi-
cant for the physician-psychiatrist and the philosopher, and one that is well-
known and widely-acknowledged within phenomenology even when it may
not always be well-performed. Going directly “to the things themselves” in
whatever way was required was a methodical directive which he took followed
rigorously.
More concretely, the method embodies a moment of concrete seeking to
help that is motivated by the equally concrete presentation of affliction (dis-
ease). Precisely this obliges the one seeking to help and to understand to fo-
cus on the dis-ease as a disruption of the “usual” or “normal,” and thus requires
the physician (and philosopher) to focus on the disruption as an example of
more generic forms of dis-lodgments (as ways-of-being-in-the-world), hence
the focus on the usual or normal itself. Straus’ method is thus a specific kind
of free-fantasy variation which, at one point in my own work, I termed “the
method of prominence through absence” (1981, pp. 242–250), or, one may
also say, through disruption or failure of the normal.

Straus’ Phenomenology

Straus believed that careful attending to the phenomenon at the same time, so
to speak, announces in advance where the inquirer-helper then had to go, what
44 RICHARD M. ZANER

was then needed for that understanding and, eventually, therapeutic help. A
passage cited above makes this point clearly. It reads: “Instead of proceeding
from philosophy to psychiatry, we shall start from psychiatry and let it lead
us to philosophical questions.” Picking up on a Husserlian methodological
point,8 he then continued: “Thus I shall apply a kind of philosophical ‘epoché,’
i.e., I will first bracket all philosophical teachings (as far as they are known to
me) and launching out from the psychiatric situation I shall expose myself to
philosophical adventures, with the risk of incurring the scorn of experts” (1966,
p. 274). Not only must I begin strictly from my own experience, but that ex-
perience itself thereby becomes a kind of discipline for the inquirer. Accord-
ingly, “If the I-world relation is first acknowledged, it should not be too difficult
to survey its disturbances,” some of which he himself studied in various of
his essays – “depersonalization, agoraphobia, the dysmnesic, the asymbolic,
and the schizophrenic” (1966, p. 274).
In another place, reflecting on hallucinations, he emphasized, “Psychotic
manifestations point, at least by implication, to a standard from which the
patient deviates.” It is thus “thanks to their strangeness, [that] hallucinations
are easily recognized as disturbances of sensory experience.” But this in and
of itself includes or pre-delineates a kind of methodological requirement. He
put it this way: “the actual interpretation of the norm, however fragmentary,
vague, and prejudiced it may be, predetermines any possible conception of
pathological phenomena.” Precisely in view of that, however, “a reappraisal
of the norm of sensory experience has become mandatory; for in everyday
life, we practice the norm – here familiarity prevents insight. . .” (1966, p. 277).
We to whom the person appeals, or is brought, for help, however, must sur-
mount precisely that familiarity in order to make the “everyday,” the “norm,”
itself thematic in its currently presented modality – to make insight possible
ultimately by or on behalf of those suffering from whatever deviation it might
be.
At the end of this reflection Straus noted that “phenomenology is the method
of choice. Instead of explaining behavior by means of physiological hypoth-
eses, reducing the I-world relation to events within an isolated organism,
phenomenology tries to understand the mentally sick by understanding first
the norm of man as a living being.” What becomes disclosed is that “halluci-
nations . . . originate in distorted modalities;” as “caricatures of normal struc-
tures, the distortions signify pathological modes of being-in-the-world” (1966,
p. 288).
Finally, in his major essay on philosophy and psychiatry, he emphasized
that even schizophrenia is a disturbance “in the progress and realization of
Dasein.” Indeed, all examples of mental dis-ease are “failures of existential
projects.” Precisely for that reason, their philosophical exploration is never
the final word; rather, in his words, “the findings of Dasein-analysis must be
translated into the language of the clinic” (1969, p. 8), that is, there is always
 A CRITICAL APPRECIATION OF ERWIN STRAUS 45

the imperative to return to the patient whose condition all along served as the
governance and aim of understanding.

The “Strange” Discipline of the Phenomenon

Straus was very clear about the reason and goal for this approach. “The medi-
cal relationship to the mentally sick person requires precisely that the patient
be evaluated as such and be cared for with the caution and concern his sick-
ness requires” (1969, p. 18). He also recognized that in clinical work the psy-
chiatrist unavoidably makes certain assumptions about such “philosophical
problems” as “self-determination,” “normal and morbid behavior,” and oth-
ers. This is unavoidable, since “philosophical problems thrust themselves
upon” every clinician – although, to be sure, a number of responses are avail-
able. For instance, one psychiatrist may follow accepted doctrines and rules
of the art; another may try to make philosophical questions thematic and even
attempt answers while still within his clinical attitude; still others, however,
try to base psychiatry on some philosophical work or other – as did both Jas-
pers and Binswanger. Such attempts, interesting in their way, “have also had
an inhibiting effect,” for in the end “the issue of the possibility of communi-
cation and comprehension, is bypassed” (1969, p. 18); the fundamental fea-
tures of human being-in-the-world ignored.
What, then? Straus is again clear. It is at just this point that he must “start
from psychiatry and let it lead us to philosophical questions” – a beginning
that not only requires “a kind of philosophical ‘epoché’,” but, I am suggest-
ing, is itself a highly concrete course or method of subsequent inquiry.
What I’ve identified as the discipline of the phenomenon is most promi-
nent just here. It might be wise to back up slightly in order to make the point
as clear as possible. Straus points out that, as a psychiatrist, he has “a certain
position and role” to fulfill, along with certain kinds of task and modes of
behavior. Obviously, becoming occupied with anything else constitutes an
interruption in his “actual psychiatric activity,” in which he has resolved to
“accept the order of the everyday human world and [to] cooperate actively in
its realization” (1969, p. 18). As psychiatrist, he addresses himself to those
fellow persons in need of help “insofar as they have failed in undisturbed co-
enactment of everyday life’s meaningful requirements” (1969, p. 18). That is,
however madness may be seen, by no matter whom it may be – curse or bless-
ing, inspiration or possession by demons, guilt or illness – all such views are
based on an encounter with human beings “with whom all mutual understand-
ing flounders, because their own standpoint in the world is deranged” (1969,
p. 18).
In this respect, the encounter with the mentally disturbed person is marked
by an experience of “strangeness” which serves the psychiatrist as a kind of
46 RICHARD M. ZANER

“practical criterion” for distinguishing between mental disease and mental

health. The psychiatrist is thus an “alienist” whose work is the interpretation
and therapy focused on and for the sake of understanding and treating “strange”
or “alienating” behavior understood as a “manifestation of sickness.”
Whether or not the precise sense of strange is conceptually clear at the outset
of an encounter, the situation is analogous to the way in which “we discover
a foreigner in the course of a conversation by his accent, i.e., by its contrast
to that familiar to us. . . .”9 Accordingly, “just as we notice grammatical er-
rors without being familiar with the rules of grammar. . .,” so, on the one hand,
is that strangeness encountered even if it is not initially understood. Strange-
ness is directly experienced in the life-world as the failure of mutual under-
standing which, on the other hand, occurs effortlessly for the most part in daily
life. The “disturbance” of understanding or intelligibility “first startles us and
makes us wonder,” it is a surprise which provokes wonder and thereby calls
for or solicits attention to itself (1969, p. 19).
Here, Straus is led to recognize that his own medical and psychiatric prac-
tice “requires insight into the possibility of mutual understanding in its elemen-
tary structure, since it underlies all social and historical variants. It thus points
to a philosophical problem which it cannot resolve by its own means” (1969,
p. 20). It is just for this reason that the psychiatrist perforce becomes philoso-
pher (whether well or poorly practiced). In any case, for him, philosophy has
“the task of revealing the axioms of everyday life and of making intelligible
the possibility of communication” – which, of course, was exactly the phe-
nomena Schutz set himself to explicate (although he does not cite Straus, nor
does Straus cite Schutz). It is in any case strictly within this ongoing dialogue
between psychiatrist and philosopher, Straus felt, that “we may finally be able
to comprehend how far the eccentricities of our fellow man . . . are to be un-
derstood as morbid, as manifestations of madness” (1969, p. 20).

Straus as Historical “Methodist”

I stated that I thought there are several crucial and fundamental methodologi-
cal themes in Straus’ work, understood as a unique blend of medical and philo-
sophical concerns. Expressed most simply, he repeatedly emphasized why,
where, and how it was essential to begin an inquiry, and where and why he
had to go thereafter. His patients – each one’s specific situation, circumstances,
and condition – invariably constitute the initiating problem, a “strangeness,”
as well as what then governs and guides the inquiry. Each patient, taken for
his or her own sake, presents as “odd,” “eccentric,” “deviant,” “mad,” and is
in this a “surprise” over against what is typically expected in the world of eve-
ryday life. That “surprise” solicits notice, in particular the specific and spe-
cial kind of notice that is typically assigned as a role to certain individuals
 A CRITICAL APPRECIATION OF ERWIN STRAUS 47

and not to others in the realm of the everyday life: the physician and psychia-
trist. But each such individual also solicits attention as an example, as ex-
emplifying certain modes of being-in-the-world that must themselves be
thoroughly grasped and understood to enable the therapeutic return in order
to help.
Though Straus did not specifically say this, it is surely a constitutive factor
that must be noted as well. Precisely because of this everyday “assignment”
of tasks and modes of behavior, the physician-psychiatrist and patient are
necessarily in an asymmetrical relationship with power on the side of the
physician-psychiatrist. The latter, not the patient, has the skills and knowl-
edge to interpret what is wrong and then to do something about it; the latter,
not the patient, has access to resources (some of which are potent and expen-
sive, such as psychotropic drugs, hospitals, etc.); the latter, not the patient,
finally, has social legitimation and legal authorization to act to, on and with
the patient – at times in highly disruptive ways. Accordingly, in trying to find
ways to help, the physician-psychiatrist encounters the patient within an un-
balanced relationship which itself becomes a structural part of the relation-
ship which is present in all subsequent understanding and efforts to help. It is
the patient’s condition as an appeal for help, in other words, whose very vul-
nerability (Zaner, 2000, pp. 123–140) constitutes the source of what guides
and governs the physician-psychiatrist’s search for the means to help and the
ways to understand. In terms used earlier, the psychiatrist is under the disci-
pline of the phenomenon, and every aspect of the search for insight and help
is conducted under that governance.
In this respect, I might suggest, Straus’ method bears important similari-
ties as well with the Gestalt-psychological insight captured by Gurwitsch in
his conception of the “context” of consciousness: just as an incompletely drawn
whole (say, a face) functions to set out lines of “good continuation” such that
only certain constituents can possibly “fulfill” those lines, so, here, the pa-
tient as (at first an only incompletely understood) phenomenon sets out “lines
of good continuation” by which not only understanding but eventually therapy
can be made available.
In just this respect, I find Straus’ work exciting indeed, for it seems to me
to have picked up on one of the most compelling and powerful movements in
the history of medicine, set out very early in ancient times. The great medical
historian Ludwig Edelstein has pointed out that this movement, known as
“skepticism” or “Methodism,” was unique in its insistence that it was the
unique, individual sick person whose condition must be taken as the guide
for medical knowledge and treatment. Indeed, the usual, generally accepted
idea – that the effort to know must guide the search for therapy, hence the gen-
eral or universal sets out and even prescribes the course of therapy – was
regarded by the skeptics as absurd, since it is the individual and only the
individual who presents for help. To the contrary, they maintained, it is solely
48 RICHARD M. ZANER

due to and within the context of therapeia that the physician can possibly come
into the only episteme needed and the only knowledge to be gleaned from
within the “art” (techne). In this sense, contrary to the dominant conception
at the time (and subsequently), the skeptics advanced the unique idea that
knowledge, medical knowledge most of all, could only concern the individual,
the particular patient – for only then could there be any treatment, the “test”
for which could only be that same patient’s actual and future reactions to what-
ever therapy was administered. In Edelstein’s succinct phrase, the “law” of
medicine is to be found in the “phainomenon itself”: that is the alpha and
omega of medicine, and it sets out the course of what must be known and what
help will at all be appropriate.
After outlining his understanding of the “Allon” in his essay on philoso-
phy and psychiatry, Straus concluded that, as “we are always under the im-
pact of the Allon,” patients and psychiatrists alike, “we are able to understand
the patients, even though we are unable to reach an understanding with them”
(1969, p. 83). Beyond that, each patient presents not only as an appeal for help,
but as an individual example of the human condition as such. Accordingly,
he thought, the title of his essay, “Psychiatry and Philosophy,” itself requires
a full examination of the conditio humana, “so that insight into its structure
will enable us to comprehend the destructions encountered on the ward” (1969,
p. 83).
In the end, what begins his inquiry – each concrete patient – also concludes
it: he must, as psychiatrist, return to the patient “encountered on the ward.”
The clinician-therapist, having been moved from the unique patient to philo-
sophic insights into Dasein, must – indeed, must now properly – return to the
patient. Medicine, which “needs an anthropological propaedeutic” (1969, p.
83), can now be grounded. If I may express it differently, if the physician seeks
the lofty eagle’s vision, he or she dare not obscure the wisdom of the com-
mon crow – closer to the earth, it is true, but to that habitus even the eagle
must return in order to help patients.

Notes

1. This article is based on a paper delivered in a symposium on the thought of Erwin W.

Straus, at the annual meeting of the Society for Phenomenology and Existential Philoso-
phy, Lexington, KY, October 16, 1997.
2. Unlike Straus and Van den Berg, after turning to philosophy Jaspers did not maintain his
psychiatric practice, nor was he a scientist like Straus. Van den Berg is an especially
important figure, but, like Straus, has suffered from relative obscurity and remained, even
in phenomenological circles, somewhat marginalized. That this is terribly unfair is obvi-
ous enough, as even a brief glance at those of his works translated into English will show
(1952, 1961).
3. See the splendid journal, Medicine, Health Care and Philosophy: A European Journal,
the official journal of the European Society for Philosophy of Medicine and Health Care.
 A CRITICAL APPRECIATION OF ERWIN STRAUS 49

4. At the University of Kentucky Pellegrino was Chair of the Department of Medicine, while
Straus was an adjunct faculty member in the School of Medicine, with his major appoint-
ment being at The Veterans Hospital in Lexington, Kentucky.
5. Straus’ essay (1969) is included along with two other essays by Maurice Natanson (who
edited this volume) and Henri Ey, reprinted from a larger work edited by W. H. Gruhle,
R. Jung, W. Mayer-Gross, and M. Müller (1963).
6. Indeed, it is precisely this feature of the Methodist tradition which prompts Edelstein to
an unusual emphasis. It constitutes, he says, “medicine’s own creation and, it seems to
me, its original contribution” (1967, p. 201, n. 18).
7. In addition to citations under “psychiatry,” “psychology,” and “Ludwig Binswanger,”
Straus is mentioned under “Body” (p. 70), “Dance” (p. 129), “Emotion” (p. 175), “France”
(p. 248), “Physical Education” (p. 535), “Post-modernism” (p. 560), “Max Scheler” (p.
630), “Somatics” (p. 665), and “United States of America” (p. 720) – each of these men-
tions, however, except those for psychiatry and psychology, are quite brief.
8. It is unclear to me whether, or to what extent, Straus was actually aware of this sort of
convergence with Husserl.
9. See Schutz’s analysis of “the stranger” for a number of interesting contrasts and conver-
gences with Straus (Schutz, 1964a).

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